OCAD MSK

The long axis images show subtle tibial deviation of the 2nd toe and sagittal images show slight hyperextension of the 2nd toe at the MPJ relative to the 3rd (not shown) suggesting 2nd MPJ instability. Surprising, but podiatrists rarely evaluate MPJ instability, although it is the single most reliable clinical finding to suggest plantar plate tear. There is full thickness tear at the lateral insertion of the 2nd MPJ plantar plate, with enthesitis and reactive marrow edema at the lateral base of the 2nd toe, and moderate plantar lateral and submetatarsal soft tissue thickening and edema.